Enhancing Surgical Care in BC - British Columbia Medical Association

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Part 3: Process Improvement Initiatives in Other Jurisdictions While many individual hospitals, particularly those in the United States, have implemented perioperative process improvement initiatives, only a few jurisdictions have attempted to take a more comprehensive and coordinated approach by implementing such initiatives in multiple hospitals across a particular region or country. Experiences from these jurisdictions, which include Australia, the United Kingdom, and parts of Canada, provide insight into how a coordinated perioperative process improvement initiative can be successfully implemented in British Columbia. I. The Experience of Other Jurisdictions Australia In 1994 the Australian Department of Health and Family Services established the National Demonstration Hospitals Program (NDHP), which focused on improving patient pre-admission and admission processes, operating suite management, and discharge planning and post-acute care (Alexander, 2000; Australian Department of Health and Family Services, 1997). Under the NDHP, 38 public hospitals were grouped into seven consortia, and major metropolitan hospitals with experience and expertise in developing best practice models were identified to lead each. The process to develop and use best practice models involved multiple stakeholders, including patients, clinical staff, hospital executives, consumer groups, professional bodies, and funding agencies. The lead hospitals then worked with and supported the other hospitals within their consortium group to transfer the use of best practice service delivery models. The key steps of the NDHP included a needs analysis of existing services, collection of data and performance indicators, implementation of best practice models, and consolidation/continuation of the new models of service delivery. At the end of the NDHP initiative an external performance evaluation was conducted. The following are some of the key outcomes: • Average hospital stays reduced 6% overall, and by more than 10% in 23% of hospitals. • Unplanned readmissions within a month of discharge reduced by nearly 27%. • Operating room utilization improved 3.1% for hospitals reporting the measure. More than 50% of hospitals achieved utilization greater than 90%. • Cancellations on the day of surgery reduced by 20% in 28% of NDHP hospitals. • Estimated net savings from all hospitals participating in the initiative between $51.5 million and $72 million per year. According to the review, the savings are substantial against the input of $11 million used to fund the program. 21 Enhancing Surgical Care in BC – Part 3: Process Improvement Initiatives in Other Jurisdictions
United Kingdom In 2009 the National Health Service (NHS) launched The Productive Operating Theatre (TPOT) Programme, designed to train and empower perioperative personnel with the knowledge and practical tools needed to improve surgical programs in their respective hospitals. TPOT provides a comprehensive package of foundation and training modules derived from Lean methodology, and is aimed at addressing specific operating room issues and processes (e.g., organization of the OR, patient preparation, scheduling, communication). The program modules are used by staff to review each perioperative component with a structured approach to help identify issues, then test, implement, and measure appropriate changes. The modules are also used by senior executive hospital leaders to determine what leadership, engagement, and support is necessary to ensure the initiative is successful in their hospitals. TPOT also provides structured train-the-trainer sessions and on-site implementation support. While the program is still relatively new, participating hospitals have self-reported improvements in the following ways: • Enhancing the safety culture, improving communication, and reducing errors by implementing structured briefing and debriefing, the WHO safety checklist, and better OR staff teamwork. • Improving efficiency and productivity by focusing on operating start time, turnaround time, more effective utilization of operating room, and staff resources. • Realizing financial savings by eliminating waste and making processes more efficient through standardization. For example, a minimum £5,000 (~$8,000 CDN) in stock reduction per OR and a minimum £9,000 (~$14,000 CDN) in recurring annual saving per OR was realized on consumables. According to the NHS, TPOT’s success is based on the fact that the perioperative teams themselves identify the problems and implement the solutions. Since the changes are specifically relevant to staff, they are more likely to be sustained. TPOT is now being implemented in hospitals throughout England, Wales, and Scotland, as well as in New Zealand. In Canada, most recently Saskatchewan has taken interest in adopting its use (Saskatchewan Ministry of Health, 26 November 2010). Ontario As part of Ontario’s 2004 Wait Time Strategy, the Ministry of Health and Long-Term Care established the Surgical Process Analysis and Improvement (SPAI) Expert Panel, along with several other expert panels. The SPAI Expert Panel was made up of leaders in health care administration, perioperative processes, surgery, materials management, and academia. It developed a comprehensive perioperative improvement plan for the province that included advice on accountability frameworks; mapping of perioperative processes; benchmark and best practice targets, information technology, and management; human resources; education; funding; and organization of regional surgical services to increase efficiencies. As part of the implementation strategy, the Surgical Efficiency Targets Program (SETP) was established and key performance indicators related to surgical process efficiency were developed (e.g., first-case on-time start, turnover time, scheduling accuracy, case cancellations). The list of indicators is identified in Exhibit 4. Standard data on operating room performance are now collected by each hospital and used by the Ministry, Local Enhancing Surgical Care in BC – Part 3: Process Improvement Initiatives in Other Jurisdictions 22
Page 1: Enhancing Surgical Care in BC Impro
Page 4 and 5: The BCMA Council on Health Economic
Page 6 and 7: Executive Summary In this policy pa
Page 8 and 9: Summary of Recommendations General
Page 10 and 11: Introduction Factors such as the in
Page 12 and 13: infections is lowered, and better m
Page 14 and 15: with the expansion of medical schoo
Page 16 and 17: Access to Postoperative Beds and Re
Page 18 and 19: V. The Case for Improving the Perio
Page 20 and 21: Six Sigma • A project-driven mana
Page 22 and 23: • Developing a clear and transpar
Page 24 and 25: especially in ORs that have a long
Page 28 and 29: Health Integration Networks (LHINs)
Page 30 and 31: Exhibit 5. Summary of Perioperative
Page 32 and 33: improving surgical quality. Without
Page 34 and 35: Part 4: Best Practices, Lessons Lea
Page 36 and 37: etter understand not only their par
Page 38 and 39: Recommendation 8 To aid the impleme
Page 40 and 41: framework to improve surgical quali
Page 42 and 43: Summary Undertaking process improve
Page 44 and 45: Darlene’s story One patient’s s
Page 46 and 47: If there was a key message Laurel w
Page 48 and 49: Patients expressed their feelings a
Page 50 and 51: • Patients would like the hospita
Page 52 and 53: Eijkemans, M. J., van Houdenhoven,
Page 54 and 55: Overdyk, F. J., Harvey, S. C., Fish
Page 56: www.bcma.org

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